증가된 C - Reactive Protein 은 관상동맥 중재술 후 재협착에 대한 유일한 예측인자

정우곤(Woo Kon Jeong),정명호(Myung Ho Jeong),김계훈(Kye Hun Kim),이상록(Sang Rok Lee),박옥영(Ok Young Park),염주협(Ju Hyup Yum),김원(Won Kim),김주한(Ju Han Kim),류제영(Jae Young Rhew),안영근(Youn Keun Ahn),조정관(Jeong Gwan Cho),안병희 대한내과학회 2002 대한내과학회지 Vol.62 No.4

연구배경: 최근에 동맥경화 및 관상동맥 질환의 발생의 중요한 역할을 하는 감염 및 염증인자에 대한 연구가 활발히 이루어지고 있다. 본 연구에서는 관상동맥 중재술 후 발생하는 재협착과 염증인자의 상관관계 및 CMV, C. pneumoniae, H. pylori 등의 감염과 상관관계에 대해서 전향적 조사를 하였다. 대상 및 방법: 1999년 9월부터 2001년 3월까지 처음으로 관상동맥 질환으로 진단된 후 관상동맥 중재술을 시행한 후 추적 관상동맥 조영술을 시행받았던 272예 중 재협착이 발생하였던 재협착군 (99명, 134병변, 59.5±10.8세)과 재협착이 발생하지 않았던 비재협착군 (173명, 211병변, 58.8±10.2세)으로 나누어, 양군간의 세 가지 감염항체의 양성률 및 역가와 CRP를 측정하여 재협착과 연관성 등을 전향적으로 분석하였다.결과: 재협착군과 비재협착군에서 C. pneumoniae, H. pylori, CMV의 항체 양성률은 각각 27.3%와 26.0%, 61.6%와 63.6%, 100%와 100%로서 양군간에 유의한 차이는 없었다. CRP의 양성률은 재협착군과 비재협착군에서 각각 57.6%와 36.4%로서 재협착군에서 유의하게 높았고 (p=0.001), CRP의 측정치는 3.38±5.80 mg/dL와 1.36±2.62 mg/dL로서 재협착군에서 유의하게 높았다 (p=0.001). 관상동맥 재협착 예측인자에 대한 다변량 회귀 분석에서 CRP는 상대위험도 2.1169, 95% 신뢰구간 1.2062∼3.7154 (p=0.009)로서 재협착 발생에 대한 유일한 독립적인 위험인자이었다. 결론: 추적 관상동맥 조영술상 재협착군과 비재협착군에서 C. pneumoniae, H. pylori, CMV의 항체 양성률은 양군간에 유의한 차이는 없었고 CRP의 양성률, 측정치 모두 유의하게 높았고, CRP는 재협착 발생을 예측할 수 있는 유일한 인자이었다. Background: Current techniques of percutaneous coronary interventions (PCI) remain limited by the restenosis. Recent studies provide evidence that inflammation plays a role in the pathogenesis of cardiovascular disease. Methods: We prospectively tested whether inflammatory markers are predictors of subsequent restenosis in 272 consecutive patients with angiographically proved coronary artery disease. The patients who underwent PCI at Chonnam National University Hospital between Sep. 1999 and Mar. 2001 were divided into two groups according to the occurrence of restenosis on follow-up coronary angiogram: patients with restenosis (Group I: n=99, 59.5×10.8 years, M:F=77:22) and patients without restenosis (Group II: n=173, 58.8×10.2 years, M:F=131:42). IgG seropositivity and titer of CMV, C. pneumoniae, H. pylori, levels of C-reactive protein (CRP) were compared between two groups. Results: There were no statistical differences in the seropositivity of CMV IgG, C. pneumoniae IgG, H. pylori IgG between two groups (Group I vs. II: 100% vs. 100%, 24.7% vs. 25.7%, 62.2% vs. 63.7% in group I vs. II respectively). Among angiographic parameters, low TIMI flow (TIMI 0 or I) was more common in Group I than in Group II (p=0.038). The patients with elevated CRP (>0.5 mg/dL) were more common in Group I than those in Group II (57.6% vs. 36.4%, p=0.001) and the value of CRP was higher in Group I than in Group II (3.3±5.8 mg/dL vs. 1.3±2.6 mg/dL, p=0.001). According to multiple logistic regression analysis, CRP was the only predictor of restenosis with odd ratio of 2.1169 (95% C.I. 1.2062-3.7154, p=0.009). Conclusion: The value of CRP is the most important predictor of restenosis after PCI. (Korean J Med 62:405-414, 2002)

긴 스텐트는 관상동맥 스텐트 재협착의 유일한 예측 인자

정명호(Myung Ho Jeong),조정관(Jeong Gwan Cho),강정채(Jung Chaee Kang),이승현(Seung Hyun Lee),홍영준(Young Joon Hong),박옥영(Ok Young Park),정우곤(Woo Kon Jung),이상록(Sang Rok Lee),김원(Woen Kim),김계훈(Kye Hun Kim),강경태(Kyung Tae 대한내과학회 2001 대한내과학회지 Vol.60 No.6

N/A Background : Coronary stenting is one of the most effective methods of percutaneous coronary interventions (PCI) in the treatment of intimal dissection and prevention of restenosis after balloon angioplasty. However, coronary stent restenosis still remains a major clinical limitation. Methods : Three hundreds seventy three patients who underwent coronary stent implantations and follow-up coronary aniograms at Chonnam National University Hospital between June 1996 and December 1999, were divided into two groups: 123 patients with restenosis (Group A: 98 male, 25 female, 58.5±9.4 year-old) and 240 patients without restenosis (Group B: 193 male, 47 female). Results : The prevalence of clinical diagnosis and risk factors for the atherosclerosis were not different between two groups. The indications for stenting and stent types, reference vessel diameter and minimal luminal diameter before stenting were not different. However, stent length was 23.4±7.57 mm in Group A and 20.8±6.58 mm in Group B, which were longer in Group A than in Group B (p=001). By multiple logistic regression analysis for the independent predictive factors for stent restenosis, the long stent more than 25mm in length was the only significant predictive factor after correction according to age, sex, risk factor, lipid profiles (OR=2.590, 95% C.I.=1.40-4.78). Conclusion : The long coronary stent more than 25 mm in length is a predictive factor of restenosis after coronary stenting.(Korean J Med 60:529-536, 2001)

급성 심근경색증 환자에서 장기 임상경과에 대한 C - Reactive Protein 의 역할

홍영준(Young Joon Hong),정명호(Myung Ho Jeong),박형욱(Hyung Wook Park),박옥영(Ok Young Park),정우곤(Woo Kon Jeong),이상록(Sang Rok Lee),염주협(Ju Hyup Yum),김원(Weon Kim),김주한(Ju Han Kim),류제영(Jay Young Rhew),안영근(Young Keun A 대한내과학회 2001 대한내과학회지 Vol.61 No.6

N/A Background: The inflammation is an important feature of atherosclerotic lesions, and high level of C-reactive protein (CRP) is known to be associated with increased coronary events and poor prognosis in acute myocardial infarction (AMI). We examined the clinical and angiographic outcomes, success rate of the percutaneous coronary intervention (PCI), and long-term survival rate after PCI according to the level of CRP on admission. Methods: Two hundred and eight patients with AMI who underwent primary or rescue PCI between 1997 and 1999 at Chonnam National University Hospital were divided into two groups: Group I (n=86, 59.9±9.3 years, male 74.4%) with normal CRP (<1.0 mg/dL, mean value=0.43±0.14 mg/dL) on admission and Group II (n=122, 59.1±10.4 years, male 83.6%) with elevated CRP ( ≥1.0 mg/dL, mean value=3.50±0.93 mg/dL) on admission. Results: There were no significant differences in baseline characteristics between two groups. The incidence of cardiogenic shock was higher in Group II than in Group I (Group I; 3/86, 3.5% vs Group II; 15/122, 12.3%, p=0.026). The coronary angiographic findings were not different between two groups. The ejection fraction and Thrombolysis In Myocardial Infarction flow were improved after PCI in both groups (Group I; 49.4±10.5 to 52.0±9.0%, 1.52±1.13 to 2.77±0.55, p<0.001 vs Group II; 50.1±11.2 to 52.7±9.7, 1.55±1.11 to 2.76±0.53, p<0.001). Primary success rate of PCI was 94.2% (81/86) in Group I and 95.1% (116/122) in Group II (p=0.776). The survival rates of Group I was 97.7%, 97.7% and 96.5%, and those of Group II was 91.8%, 91.0% and 86.9% at 1, 6 and 12 months, respectively (p=0.043 at 1 month, p=0.040 at 6 months, p=0.018 at 12 months). Conclusion: Higher incidence of cardiogenic shock and worse long-term survival after PCI are observed in AMI patients with elevated CRP.(Korean J Med 61:606-615, 2001)

원인 불명 실신에서 기립경사검사 결과의 예측

정은아(Eun A Chung),이승현(Seung Hyun Lee),홍영준(Young Joon Hong),박옥영(Ok Young Park),정우곤(Woo Kon Jeong),이상록(Sang Rok Lee),이상현(Sang Hyun Lee),강경태(Kyung Tae Kang),류제영(Jay Young Rhew),박종철(Jong Cheol Park),안영근(Yo 대한내과학회 2001 대한내과학회지 Vol.61 No.2

N/A Background : Vasovagal syncope has been believed to account for the majority of syncope of unknown origin (SUO). Head-up tilt test (HUT) has been well recognized as a useful test in the evaluation of SUO. The purpose of this study was to determine the predictors of HUT to develop a less time-consuming test protocol and get an information on the pathophysiology of vasovagal syncope. Methods : Eighty five patients (mean age, 43±18 years: 47 men, 38 women) underwent a 80 degree HUT without or with isoproterenol infusion (2 μg/min and 5 μg/min, each for 6 minutes) for unexplained syncope or pre-syncope. Positive HUT was defined as symptomatic hypotension (systolic blood pressure ≤80 mm Hg) and/or symptomatic bradycardia (≤45/min for ≥10 seconds) or asystole ≥3 seconds. The patients were divided into two groups according to the result of the HUT: Group I included 47 patients (M:F=25:22) with positive result, Group II, 38 patients (M:F=22:16) with negative result. Results : Group I patients had more episodes of syncope than Group II (3.1±2.5/year vs. 2.0±2.1/year, p<0.05). There were no significant differences between the 2 groups in the heart rate (HR), systolic and diastolic blood pressure (BP) at the baseline supine position. BP after tilt was not significantly different between 2 groups except for systolic BP at 6 minutes after tilt, which was significantly lower in Group I than Group II (109.5±17.5 mm Hg vs. 118.1±18.2 mm Hg, p<0.05). However, HR after tilt was significantly faster in Group I than Group II (81.1±15.1/min vs. 74.2±14.9/min, p<0.05 at 2 minutes after tilt; 83.7±14.4/min vs. 74.6±14.7/min, p<0.01 at 4 minutes after tilt). The increase in HR was greater in Group I than Group II (19.9±12.6/min vs. 12.8±10.6/min, p<0.001). In the prediction of positive HUT with HR rise above 14/min during the early 6 minutes of baseline head-up tilting, the specificity, sensitivity, and positive predictive value were 63.2%, 70.2%, and 70.2%, respectively. Conclusion : In patients with SUO, positive HUT can be predicted with the early HR response during head-up tilt. This result shows that vasovagal syncope is triggered by exaggerated HR response to the decreased venous return and allow us to develop a less time-consuming HUT protocol.(Korean J Med 61:133-140, 2001)